WHO GEARS UP FOR COUNTRY-LEVEL MATERNAL AND CHILD HEALTH PUSH

DR ELIZABETH MASON, WHO*

For the past decade, the Millennium Development Goals (MDGs) have been a powerful force in the fight to reduce poverty and inequity, and critically, they have helped to place better health at centre stage in the development agenda.

As we approach the Secretary-General’s Highlevel session on the MDGs in September, and look beyond to the target date of 2015, let us celebrate the achievements to date, identify best practices and push on with even greater determination to improve the health and lives of women and children everywhere.

In July 2010, WHO’s Director-General announced that, in view of the heightened commitment to maternal, newborn and child health, and in order to consolidate and strengthen the Organization’s work in this important area, a new Department is being created. The work of the new Department for Maternal, Newborn, Child and Adolescent Health and Development will cover a wide range of activities, from the development of global guidelines to their application in countries, as well as strengthening implementation and monitoring progress.

The focus on quantitative, time-bound goals has been a stimulus to measure results, and has helped to set priorities and assess performance. It has revealed that progress is mixed, between regions and between the MDGs. For instance, the proportion of births attended by a skilled health worker has increased globally, but in Africa and South- East Asia fewer than 50% of all births have skilled attendants. In addition, we know that while child mortality has dropped overall (down by 30% since 1990), newborn deaths remain persistently high, with 3.6 million babies still dying in their first month of life every year. The MDGs also show that there are well-performing countries in slow progress regions, and vice versa. This forces us to better understand the factors that promote success and to think harder about the nature of constraints. Moreover, measuring progress on the MDGs highlights the fact that data, and the lack of investment in health systems at country level needed to produce it, remain as significant problems.

Through the MDGs, the need to reduce maternal and newborn deaths has emerged as the most urgent and obvious priority. While recent estimates suggest there has been some progress in reducing maternal mortality, the slow rate of decline means that MDG 5 is unlikely to be reached in most low-income countries. Success will require access to interventions across a continuum: from pre-pregnancy, pregnancy and childbirth, the immediate post-natal period, childhood and into adolescence. Cost-effective interventions (such as access to contraception, ante-natal care, facility-based delivery, immunization and the prevention and treatment of childhood illness) are necessary, but insufficient without parallel efforts to strengthen health delivery systems and address the broader social and economic determinants of women’s and children’s health.

In April, following a high-level retreat, the UN Secretary General Ban Ki-moon launched a “Joint Action Plan for Women’s and Children’s Health” which builds on previous discussions within the UN and regional commitments and plans. It seeks to revitalize existing efforts, secure new national and international commitments and ensure accountability for delivering results.

Against this backdrop of strong political will and the promise of additional financial resources, it is crucial that global initiatives are followed-up by concrete action in countries. This includes support for the development and implementation of national strategies and plans for maternal, newborn and child health, as well as capacity building for delivering key interventions at scale. Within the “UN family” WHO is working with UNICEF, UNFPA and the World Bank (known together as the “H4”) as well as UNAIDS on harmonizing approaches and joint support to countries for accelerated implementation.

* Dr. Elizabeth Mason is Director, Department of Maternal, Newborn, Child and Adolescent Health and Development at WHO